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What to Do When Someone Is Suicidal

What do you do if your young adult daughter tells you she’s thinking about killing herself?

This was the issue facing 19-year-old Madison Holleran’s parents James and Stacy in December. “We knew she needed help. She knew she needed help,” her father told the New York Post.

The University of Pennsylvania freshman’s parents did what they thought was right. They talked with Madison. They encouraged Madison to make an appointment with a therapist who could prescribe anti-depressant medication. They suggested she take time off from school. Even as her father was driving Madison back to Penn on January 11, he told her he’d support her decision to transfer schools if she wanted. He offered to drive her to Chapel Hill so she could look at the University of North Carolina.

I probably would have done the same thing.

But Madison said she’d made plans with a friend in Philadelphia that she needed to keep. Even once Madison was back at school, her father stayed in contact with her, texting often.

On January 17, the beautiful track star from New Jersey plunged from the roof of a parking garage, killing herself.

Suicide has no demographic boundaries, affecting people regardless of their gender, race, socioeconomic status, culture, or religion. According to the American Foundation for Suicide Prevention1, approximately one million people attempt suicide each year. In 2010, the most recent year for which data exist, 38,364 Americans took their own lives; that’s one suicide every 13.7 minutes. Suicide is the 10th leading cause of death among all Americans and the third leading cause of death among people Madison’s age (15-24 years)2. Unlike many other leading causes of death, the number of people who commit suicide grows each year.

Risk factors for suicide exist. 90% of people who die by suicide have a potentially treatable mental disorder at the time of their death—a disorder often unrecognized and untreated. Other risk factors include a previous suicide attempt, family history of attempted or completed suicide, history of trauma or abuse, and chronic pain or serious medical condition. Stressors such as losing someone close, financial loss, trouble with the law, and bullying can make people susceptible to suicide.

Like Madison, people who die by suicide usually show some indication of immediate risk before their deaths. Madison told her parents she was thinking about killing herself. Other warning signs of suicide include feeling hopeless, trapped, desperate, humiliated, and losing interest in things. Madison had lost confidence in academics and in her track abilities. Some people develop insomnia, isolate themselves from family and friends, and become irritable.

“Was there anything else Madison’s parents could have done to help her?” I asked my friend. She understands suicide. She’s a mental health practitioner who, years ago in the throes of desperation, swallowed too many pills. Luckily, she survived.

“Absolutely,” she said. “If a person is threatening, talking about, or making plans to commit suicide, it’s a crisis requiring immediate attention. Madison needed hospitalization; a safe environment, until she no longer had suicidal thoughts. Her depression needed to be aggressively treated and that can’t be done on an outpatient basis.”

“What if there’s no hospital bed available? Look at the disaster that ensued when Virginia Senator Deeds tried to get his suicidal son hospitalized.”

“Then you put the kid on suicide watch for 24 hours and don’t let her out of your sight. Depression has gotten too serious by the time someone starts talking about suicide.”

What my friend said made sense. It’s also consistent with what the American Federation for Suicide Prevention recommends. According to its website, 50-75% of people who attempt suicide tell someone about their intention. If someone shows the warning signs, they must be taken seriously.

But most parents are like James, Stacy, and me. They don’t know what to do when someone talks about suicide3. Moreover, a large study of suicide intervention skills of community and health professionals found that new volunteers at a suicide crisis line, pharmacists, and psychology students also didn’t know how to respond to people talking about suicide and that general practitioners, hospital nurses, and police had levels of knowledge that were barely acceptable4. Only community mental health center staff and experienced volunteers at suicide crisis lines knew the appropriate responses.

Now you can know too. If someone you know shows the warning signs of suicide:

Tell the person you’re concerned about him/her.

Don’t be afraid to ask whether the person is considering suicide and whether they have a particular plan in mind. These questions will not push the person toward suicide if they weren’t considering it.

Ask if the person is seeing a doctor or taking medication. If so, encourage them to contact the treating physician immediately. Offer to go to the appointment with the person. If not, help them find a mental health professional and make an appointment or take them to a walk-in clinic at a psychiatric hospital or a hospital emergency room.

Don’t argue someone out of suicide. Let the person know that you care, that they are not alone, and that they can get help. Don’t say things like “You have so much to live for” or “If you kill yourself, it will hurt your family.”

Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Do not leave the person alone.

At Madison’s funeral, her father urged the congregation to learn from his loss. The lesson for us is that we can take action to prevent a suicide.

No parent should have to live with the legacy of a child’s suicide. Share this blog with a friend. Maybe you’ll save someone’s life.

When you know about a person who is thinking of suicide and you simply don't know how to deal with her or him, then prayer is the solution. When you find no solution at hand, praying with full heart can make a big difference. Prayers actually send positive vibrations to the soul of that person, which can save her or him. I just recently came across a good explanation on consequences of suicide:

I lost my sister to suicide after she struggled for four years with a very serious mental illness. My sister was 19 at the time and I was 25. It does not seem possible that the information on dadaghagwan.org could be comforting to someone who lost a loved one to suicide. If you have lost a loved one to suicide and this information has been helpful to you, then that is great. I wish nothing more than for anyone who has lost a loved one to suicide to find something that helps them grieve such a terribly tragic loss. However, if you have not lost a loved one to suicide, please do not share this information.

Prayer is helpful for some people, but for other people it is not a useful contemplative practice. And prayer alone will never be enough to help an individual who has a mental illness.

What is a person supposed to do, hospitalize someone every time he or she expresses suicidal thoughts? Don't think so. Her parents did the right thing encourgaing her to seek treatment. Even when a person does seek treatment it does not make those thoughts go away. Therapy simply provides an outlet, coping strategies and maybe some medication. When it comes down to it the individual may feel some relief, but that feeling still lingers day after day. Yes, depression is treatable, but it does not permanently vanish and individuals may continue to experience and express suicidal thoughts. A suicidal person cannot be kept in a hospital every day of his or her life. In the end people can do the best they can to help, but it is ultimately the suicidal person's decision. A temporary solution may not fix a permanent problem.

As I mentioned in my response above, my sister was 19 when she took her life. I am not a mental health professional, but my sister died at the same age as Madison who is mentioned in Dr. Pruchno's blog today and so I believe I may have some insights that are helpful.

In her article today Dr. Pruchno mentioned that "suicide is the third leading cause of death among people Madison’s age (15-24 years)." So, yes, anytime anyone expresses suicidal thoughts, especially someone 15-24 years of age, 911 should be called or a suicidal hotline or the individual should be rushed to the nearest hospital.

I battle depression daily and fall into the the high risk category (15-24).Thankfully, I have coping strategies in place and support when I need it. What I am trying to say is in the long run a depressed person still battles suicidal tendencies daily even if he or she seeks help. The individual may still suffer internally with therapy and medication. Basically, therapy is a life vest for someone who is drowning. Hospitalizing a depressed person may help, but often times he or she relapses with medication and other treatments. Some individuals are treatment resistant. Is the depressed individual supposed to suffer silently through life just because their family members do not want them to die? Along with the societal belief that suicide is such a terrible thing. In a way it is similar to taking someone off of life support. Is it worth it to watch a loved one suffer for years, even if they receive treatment? There are a bunch of gray areas regarding depression and suicide. Even if a suicidal person calls a hotline they often are provided resources, not much immediate counseling. Go to the emergency room and a suicidal person might have to wait in the waiting room for hours before being evaluated. Then there is the dilemma that many depressed people face of not being able to afford treatment. Luckily, a lot of colleges provide counseling services for students. But, those that are not enrolled in college and are independent from their parents may struggle the most paying for long term therapy and medication. People make it sound so easy to get help, but in reality it is not. There are many people who fall deeper into depression because they can't afford help and truly believe no one cares about them. Yes, there are support groups, but it is not the same as being one on one with a therapist. Overall, society acts like they are trying to help suicidal people by providing hotlines and hospitalizing people, when neither are very effective. Unless the depressed person is evaluated and treated by a licensed mental healthcare professional he or she may not feel much relief.

In my own experience, rushing someone to the hospital when they are having suicidal thoughts can be detrimental. It really depends on the person and the level of care at the hospital. If I knew that I'd be immediately rushed to the hospital to be left vulnerable to the very likely possibility of rude, disrespectful nurses and forced medication every time I raise my voice or cry, not to mention the sometimes days you spend waiting locked up in a mental health "holding cell", I'd tell no one. At all. Ever. Especially since I have PTSD and being locked in a room for days and at the mercy of people who often think they know best or know everything. What a horrifying experience! Unless you are also advocating for better quality, more compassionate mental health care as well, please don't suggest such exaggerated responses. There are other resources if the person is not in immediate danger (such a crisis lines, a mobile crisis team, their psychiatrist if they have one, the emergency psychiatry team, etc). If the person is in immediate danger, then absolutely you are right of course! :) But sending a suicidal person to an environment where they are treated very poorly... well that wouldn't make me want to live, now would it? If the system of care is improved, then this would be an option. But until then, I'd rather avoid being dehumanized and mistreated and shamed.